Efficacy and safety of controlled hypotension for total hip or knee replacement: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YU Rou ¹ ,  LIU Jin ²

1. West China School of Medicine, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

LIU Jin, Email: scujinliu@foxmail.com

Keywords：

Controlled hypotension; Arthroplasty; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202002120

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.Results A total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=?267.35, 95%CI ?314.54 to ?220.16, P<0.000 01), allogeneic blood transfusion (MD=?292.84, 95%CI ?384.95 to ?200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=?1.08, 95%CI ?1.82 to ?0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=?0.11, 95%CI ?0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI ?152.57 to 268.44, P=0.59).Conclusions The current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： YU Rou, LIU Jin. Efficacy and safety of controlled hypotension for total hip or knee replacement: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(1): 40-46. doi: 10.7507/1672-2531.202002120 Copy

1.	Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet, 2013, 381(9880): 1855-1865.
2.	余微萍, 徐旭仲, 樓文文, 等. 高容血液稀釋聯合控制性降壓對腰椎手術病人血流動力學和氧代謝的影響. 中華麻醉學雜志, 2004, 24(7): 485-488.
3.	Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.
4.	Meara JG, Smith EM, Harshbarger RJ, et al. Blood-conservation techniques in craniofacial surgery. Ann Plast Surg, 2005, 54(5): 525-529.
5.	姚尚龍, 王俊科, 于布為, 等. 臨床麻醉學. 北京: 人民衛生出版社, 2004: 180-191.
6.	Petrozza PH. Induced hypotension. Int Anesthesiol Clin, 1990, 28(4): 223-229.
7.	Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
8.	劉佩蓉, 刁樞, 孫海峰, 等. 硝普鈉控制性降壓對老年高血壓患者髖關節置換術后認知功能和腦氧代謝的影響. 臨床麻醉學雜志, 2009, 25(6): 500-501.
9.	劉學斌. 全髖關節置換術中硝酸甘油聯合瑞芬太尼控制性降壓的效果觀察. 河南外科學雜志, 2015, (1): 68-69.
10.	劉沁爽, 張志利, 孫海軍, 等. 瑞芬太尼聯合硝酸甘油控制性降壓對全髖關節置換術后老年患者認知功能的影響. 河北醫藥, 2011, 33(15): 2283-2284.
11.	周克亭, 劉志群, 鄒偉偉. 控制性降壓復合急性高容血液稀釋在全髖關節置換術中應用的觀察. 華中醫學雜志, 2007, 31(2): 90-91.
12.	孟建, 宋兆卿, 王靜. 急性高容量血液稀釋聯合控制性降壓在髖關節置換術中的應用. 中華臨床醫師雜志(電子版), 2016, 10(3): 443-445.
13.	李洪圖, 單曉輝. 控制性降壓在膝關節置換手術中的應用. 中國社區醫師(醫學專業), 2010, 12(2): 44-45.
14.	李貝, 彭丹丹, 譚堅毅, 等. 控制性降壓復合腰-硬聯合麻醉下老年髖關節置換術的臨床觀察. 吉林醫學, 2018, 39(10): 1883-1885.
15.	楊虎, 王波, 陳華, 等. 氨甲環酸聯合控制性降壓對全膝關節置換術患者療效及圍手術期失血的影響. 河北醫藥, 2017, 39(20): 3092-3094, 3098.
16.	林華陽, 饒福東, 林潔, 等. 控制性低血壓技術在單次椎管內麻醉膝關節置換術的應用效果. 臨床麻醉學雜志, 2013, 29(5): 481-483.
17.	涂素蘭, 李焯文, 陳梁. 急性高容血液稀釋聯合控制性降壓在老年人髖關節置換術中的應用. 右江民族醫學院學報, 2003, 25(4): 503-505.
18.	董魯平. 全髖關節置換術中瑞芬太尼聯合硝酸甘油降壓效果的觀察. 河南外科學雜志, 2012, 18(6): 65-66.
19.	趙若光, 林瑩, 鄒聰華, 等. 右美托咪啶控制性降壓對膝關節置換術效果的臨床分析. 福建醫藥雜志, 2015, 37(3): 85-87.
20.	金孝梁, 呂文艷, 陳志斌, 等. 急性高容量血液稀釋聯合控制性降壓和自體血回收在全髖關節置換術中的應用. 臨床麻醉學雜志, 2008, 24(7): 574-576.
21.	錢建華, 韓冬梅, 孟凡民. 控制性降壓在全髖關節置換手術中的應用. 中醫正骨, 2005, 17(7): 14-14.
22.	陳江紅, 羅軍懷. 硝酸甘油控制性降壓對七氟醚麻醉下髖關節置換術后老年患者認知功能的影響. 中國醫師雜志, 2012, 14(1): 76-78.
23.	莊心良, 曾因明, 陳伯鑾. 現代麻醉學(3 版). 北京: 人民衛生出版社, 2003.
24.	Zhang XL, Cheng T, Zeng BF, et al. Experts' consensus on minimally invasive surgery for total joint arthroplasty. Orthop Surg, 2011, 3(3): 147-151.
25.	Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
26.	周衛, 劉東海, 馬國濤, 等. 全膝關節置換過程中應用氣囊止血帶與高凝狀態的關系. 中國組織工程研究與臨床康復, 2011, 15(9): 1541-1544.
27.	Botto F, Alonso-Coello P, Chan MT, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology, 2014, 120(3): 564-578.
28.	Lienhart A, Auroy Y, Péquignot F, et al. Survey of anesthesia-related mortality in France. Anesthesiology, 2006, 105(6): 1087-1097.
29.	Monk TG, Saini V, Weldon BC, et al. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg, 2005, 100(1): 4-10.
30.	Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology, 2017, 126(1): 47-65.
31.	Paul JE, Ling E, Lalonde C, et al. Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: a meta-analysis of randomized controlled trials. Can J Anaesth, 2007, 54(10): 799-810.
32.	Sizer SC, Cherian JJ, Elmallah RD, et al. Predicting blood loss in total knee and hip arthroplasty. Orthop Clin North Am, 2015, 46(4): 445-459.
33.	陳良龍, 王萬春, 毛新展, 等. 老齡患者全髖膝關節置換術失血量的及時評估和處理. 中南大學學報(醫學版), 2007, 32(2): 316-319.
34.	Llamas-Velasco S, Llorente-Ayuso L, Contador I, et al. Spanish versions of the Minimental State Examination (MMSE). Questions for their use in clinical practice. Rev Neurol, 2015, 61(8): 363-371.
35.	Erdem AF, Kayabasoglu G, Tas Tuna A, et al. Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study. J Clin Monit Comput, 2016, 30(5): 655-660.
36.	Edwards H, Rose EA, Schorow M, et al. Postoperative deterioration in psychomotor function. JAMA, 1981, 245(13): 1342-1343.
37.	Kadoi Y, Saito S, Goto F, et al. Decrease in jugular venous oxygen saturation du ring normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients. J Am Coll Cardiol, 2001, 38(5): 1450-1455.

1. Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet, 2013, 381(9880): 1855-1865.
2. 余微萍, 徐旭仲, 樓文文, 等. 高容血液稀釋聯合控制性降壓對腰椎手術病人血流動力學和氧代謝的影響. 中華麻醉學雜志, 2004, 24(7): 485-488.
3. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.
4. Meara JG, Smith EM, Harshbarger RJ, et al. Blood-conservation techniques in craniofacial surgery. Ann Plast Surg, 2005, 54(5): 525-529.
5. 姚尚龍, 王俊科, 于布為, 等. 臨床麻醉學. 北京: 人民衛生出版社, 2004: 180-191.
6. Petrozza PH. Induced hypotension. Int Anesthesiol Clin, 1990, 28(4): 223-229.
7. Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth, 2015, 115(3): 418-426.
8. 劉佩蓉, 刁樞, 孫海峰, 等. 硝普鈉控制性降壓對老年高血壓患者髖關節置換術后認知功能和腦氧代謝的影響. 臨床麻醉學雜志, 2009, 25(6): 500-501.
9. 劉學斌. 全髖關節置換術中硝酸甘油聯合瑞芬太尼控制性降壓的效果觀察. 河南外科學雜志, 2015, (1): 68-69.
10. 劉沁爽, 張志利, 孫海軍, 等. 瑞芬太尼聯合硝酸甘油控制性降壓對全髖關節置換術后老年患者認知功能的影響. 河北醫藥, 2011, 33(15): 2283-2284.
11. 周克亭, 劉志群, 鄒偉偉. 控制性降壓復合急性高容血液稀釋在全髖關節置換術中應用的觀察. 華中醫學雜志, 2007, 31(2): 90-91.
12. 孟建, 宋兆卿, 王靜. 急性高容量血液稀釋聯合控制性降壓在髖關節置換術中的應用. 中華臨床醫師雜志(電子版), 2016, 10(3): 443-445.
13. 李洪圖, 單曉輝. 控制性降壓在膝關節置換手術中的應用. 中國社區醫師(醫學專業), 2010, 12(2): 44-45.
14. 李貝, 彭丹丹, 譚堅毅, 等. 控制性降壓復合腰-硬聯合麻醉下老年髖關節置換術的臨床觀察. 吉林醫學, 2018, 39(10): 1883-1885.
15. 楊虎, 王波, 陳華, 等. 氨甲環酸聯合控制性降壓對全膝關節置換術患者療效及圍手術期失血的影響. 河北醫藥, 2017, 39(20): 3092-3094, 3098.
16. 林華陽, 饒福東, 林潔, 等. 控制性低血壓技術在單次椎管內麻醉膝關節置換術的應用效果. 臨床麻醉學雜志, 2013, 29(5): 481-483.
17. 涂素蘭, 李焯文, 陳梁. 急性高容血液稀釋聯合控制性降壓在老年人髖關節置換術中的應用. 右江民族醫學院學報, 2003, 25(4): 503-505.
18. 董魯平. 全髖關節置換術中瑞芬太尼聯合硝酸甘油降壓效果的觀察. 河南外科學雜志, 2012, 18(6): 65-66.
19. 趙若光, 林瑩, 鄒聰華, 等. 右美托咪啶控制性降壓對膝關節置換術效果的臨床分析. 福建醫藥雜志, 2015, 37(3): 85-87.
20. 金孝梁, 呂文艷, 陳志斌, 等. 急性高容量血液稀釋聯合控制性降壓和自體血回收在全髖關節置換術中的應用. 臨床麻醉學雜志, 2008, 24(7): 574-576.
21. 錢建華, 韓冬梅, 孟凡民. 控制性降壓在全髖關節置換手術中的應用. 中醫正骨, 2005, 17(7): 14-14.
22. 陳江紅, 羅軍懷. 硝酸甘油控制性降壓對七氟醚麻醉下髖關節置換術后老年患者認知功能的影響. 中國醫師雜志, 2012, 14(1): 76-78.
23. 莊心良, 曾因明, 陳伯鑾. 現代麻醉學(3 版). 北京: 人民衛生出版社, 2003.
24. Zhang XL, Cheng T, Zeng BF, et al. Experts' consensus on minimally invasive surgery for total joint arthroplasty. Orthop Surg, 2011, 3(3): 147-151.
25. Thorey F, Stukenborg-Colsman C, Windhagen H, et al. The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty: a prospective randomized study. Technol Health Care, 2008, 16(2): 85-92.
26. 周衛, 劉東海, 馬國濤, 等. 全膝關節置換過程中應用氣囊止血帶與高凝狀態的關系. 中國組織工程研究與臨床康復, 2011, 15(9): 1541-1544.
27. Botto F, Alonso-Coello P, Chan MT, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology, 2014, 120(3): 564-578.
28. Lienhart A, Auroy Y, Péquignot F, et al. Survey of anesthesia-related mortality in France. Anesthesiology, 2006, 105(6): 1087-1097.
29. Monk TG, Saini V, Weldon BC, et al. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg, 2005, 100(1): 4-10.
30. Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Anesthesiology, 2017, 126(1): 47-65.
31. Paul JE, Ling E, Lalonde C, et al. Deliberate hypotension in orthopedic surgery reduces blood loss and transfusion requirements: a meta-analysis of randomized controlled trials. Can J Anaesth, 2007, 54(10): 799-810.
32. Sizer SC, Cherian JJ, Elmallah RD, et al. Predicting blood loss in total knee and hip arthroplasty. Orthop Clin North Am, 2015, 46(4): 445-459.
33. 陳良龍, 王萬春, 毛新展, 等. 老齡患者全髖膝關節置換術失血量的及時評估和處理. 中南大學學報(醫學版), 2007, 32(2): 316-319.
34. Llamas-Velasco S, Llorente-Ayuso L, Contador I, et al. Spanish versions of the Minimental State Examination (MMSE). Questions for their use in clinical practice. Rev Neurol, 2015, 61(8): 363-371.
35. Erdem AF, Kayabasoglu G, Tas Tuna A, et al. Effect of controlled hypotension on regional cerebral oxygen saturation during rhinoplasty: a prospective study. J Clin Monit Comput, 2016, 30(5): 655-660.
36. Edwards H, Rose EA, Schorow M, et al. Postoperative deterioration in psychomotor function. JAMA, 1981, 245(13): 1342-1343.
37. Kadoi Y, Saito S, Goto F, et al. Decrease in jugular venous oxygen saturation du ring normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients. J Am Coll Cardiol, 2001, 38(5): 1450-1455.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of controlled hypotension for total hip or knee replacement: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content